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What is the Best Sitting Posture for Labor Neuraxial Approach: A Randomized Ultrasound and Survey Study
Abstract Number: SAT-53
Abstract Type: Original Research
Labor neuraxial analgesia and anesthesia are commonly administered to parturients who undergo labor and/ or cesarean delivery. In the United States, labor neuraxial technique is often performed with the parturients in the sitting position. However, there is wide variation of sitting postures that provider may choose. During the recent years, ultrasound (US) has been used as point of care device to assist neuraxial placement. Our goal of this study was to use US to evaluate the lumbar spine anatomical landmarks in order to determine the best sitting posture for neuraxial approach.
Thirty termed parturients were recruited for this study. They were positioned into 5 different sitting postures in a randomized sequence. These 5 sitting postures were sitting with feet dangling (P1), sitting with the feet on support (P2), sitting with the legs stretching straight forward (P3), sitting with the crossed legs (lotus position) (P4), and sitting with embracing the partner in front (P5). Lumbar spinous process intervals and the articular process facet joint intervals between L2-L3, L3-L4, L4-L5 levels were measured. All parturients were inquired for their ranks of these postures with their preferences. A Student’s T test was used in the analyses.
Our data did not show evidence that any one particular posture was overwhelmingly better than others in terms of providing wider space for lumbar neuraxial approach. With regards to parturients’ preferences, there were 16 (53.3%) parturients who ranked the P5 the best.
Keplinger studied the lumbar anatomical changes throughout pregnancy, during which they concluded that L2-3 level is the most appropriate puncture site for epidural placement in parturients. Our study could not provide a rank of among the 5 sitting postures with regard to the lumbar spine openings. At the L3-4 interval, there are several comparisons between postures with statistical significance, indicating it is the most versatile interspace among the lumbar area that studied. From the parturients’ perspectives, P5 was the most preferred posture, which could be resulted from the intimate contact that it offered with their partners who provided emotional and physical support to their labor and delivery processes.
1. Chin KJ, et al. Curr Opin Anaesthesiol 2011;24(5):567
2. Keplinger M, et al. Anaesthesia 2016. doi: 10.111/anae.13399
3. Ramsay N, et al. Br J Anaesth 2014; 112(3):556